Testosterone is the same hormone whatever your gender. Ovarian function, adrenal production, current hormone treatment and the reason for prescribing are the useful distinctions. This guide focuses on menopause care: distressing low desire can deserve an HSDD assessment, but fatigue, brain fog or reduced training response don't by themselves show that you need testosterone.
Testosterone in three answers.
What it does
Ovaries and adrenal glands contribute to testosterone production. Testosterone acts in sexual and other body tissues, but a hormone's biological role doesn't prove that taking extra treats fatigue, brain fog, mood changes, muscle loss or bone loss.
What changes in perimenopause
A 2025 cross-sectional Australian study of 1,104 women found median testosterone about 25% lower at ages 55–59 than at 40–44, with the lowest point near 58–59. Among participants aged 48–53, levels didn't differ by menopausal stage. These were comparisons between people, not a measured decline within each person, and menopause alone wasn't supported as a reason to supplement testosterone.
Where you'll feel it
Persistent low desire that troubles you deserves a conversation. Pain, sleep, medicines, health and relationship context can all matter. Fatigue, brain fog or a change in training response can't diagnose low testosterone, and a blood result alone can't diagnose hypoactive sexual desire disorder (HSDD).
Noticing, assessment and follow-up
Your next steps
For yourself, or for your next appointment. These are questions and things to notice, not a diagnosis or a treatment plan.
What can I notice?
- If low desire is troubling you, note the change, related distress, pain, sleep, medicines and anything in your relationship or life that feels relevant. A low blood result alone doesn't establish the cause or a treatment need.
- During a prescribed HSDD trial, notice benefit as well as acne, new facial or body hair, scalp hair loss or voice changes. This section concerns menopause-related care, not gender-affirming hormone treatment, which has different goals.
Could a test help?
- ISSWSH recommends total testosterone and SHBG, liver-function tests and fasting lipids before a treatment trial; repeat total testosterone 3–6 weeks after starting, within 6 weeks after a dose increase, then every 4–6 months once stable. The Global Consensus uses a 6-month ongoing monitoring interval. Both include clinical response and signs of androgen excess; these aren't tests to diagnose low desire. If there's no benefit by 6 months, treatment should stop with the prescriber.
What happens next?
- Agree on the treatment goal and review dates before starting. Evidence supports testosterone for postmenopausal hypoactive sexual desire disorder (HSDD) after assessment; it doesn't establish benefit for fatigue, brain fog, muscle or bone symptoms. Blood levels help prevent excess exposure, rather than targeting a number to improve desire.
When shouldn't I wait?
- Contact your prescriber promptly about new voice changes, marked hair changes or other androgenic effects. Don't increase the dose yourself or wait for the routine review if side effects appear. Some changes may not reverse.
- Chest pain, sudden breathlessness, fainting or stroke-like symptoms need emergency help, whatever treatment you're taking.
What to say out loud.
For menopause care, the evidence-based indication is HSDD after menopause, following a full assessment. Ask which symptom treatment is intended to help, what alternatives fit, and how benefit, side effects and blood levels will be reviewed. Gender-affirming testosterone and treatment of testicular hypogonadism have different indications and treatment goals.
Pick the part you came for.
4 sections. Open one, skip the rest — nothing here depends on reading in order.
Age, ovarian function and testosterone
Age comparisons aren't a menopause cliff
A 2025 cross-sectional Australian study of 1,104 women found median testosterone about 25% lower at ages 55–59 than at 40–44, with the lowest point near 58–59. Among participants aged 48–53, levels didn't differ by menopausal stage. These were comparisons between people, not a measured decline within each person, and menopause alone wasn't supported as a reason to supplement testosterone.
Read the rest
Removing both ovaries can reduce testosterone production, but that doesn't automatically mean testosterone treatment is needed. The HSDD evidence includes naturally and surgically postmenopausal women. The 2025 age study wasn't a treatment trial and doesn't establish what any individual needs.
Hypoactive sexual desire disorder (HSDD), the evidence-based indication
What the evidence supports, and where it stops
Randomised trials in postmenopausal women with HSDD found modest improvements in sexual desire and related sexual outcomes. The 2019 Global Consensus Position Statement supports this use after a full assessment, including after removal of both ovaries. Ovarian surgery alone isn't an indication for testosterone treatment.
Read the rest
The evidence doesn't establish testosterone as a treatment for muscle strength, bone density, mood, cognition or fatigue. These symptoms deserve assessment in their own right. The trial populations don't establish benefit for every hormone history or for people before menopause.
Route and monitoring
A monitored trial, with a clear treatment goal
For HSDD after menopause, guidance favours a transdermal preparation with blood levels kept within the reference range for premenopausal women. That's the guideline's reference population, not a treatment target for every body or for gender-affirming care. Ask your doctor or specialist for product-specific written instructions rather than working out a dose yourself.
Read the rest
ISSWSH recommends total testosterone and SHBG, liver-function tests and fasting lipids before a treatment trial; repeat total testosterone 3–6 weeks after starting, within 6 weeks after a dose increase, then every 4–6 months once stable. The Global Consensus uses a 6-month ongoing monitoring interval. Both include clinical response and signs of androgen excess; these aren't tests to diagnose low desire. If there's no benefit by 6 months, treatment should stop with the prescriber.
Pellets and injections — why the guidelines say no
The pellet conversation, in plain English
For postmenopausal HSDD, the global consensus advises against preparations that produce testosterone levels above the premenopausal reference range, including pellets and injections. Compounded preparations aren't recommended routinely because efficacy, safety and product consistency aren't established to the same standard.
Read the rest
A pellet can't be adjusted as easily as a daily preparation. Excess testosterone can cause unwanted hair growth, acne and other androgenic effects; some changes, including voice changes, may not reverse. If pellets are suggested, ask why, how levels will be monitored, and what the plan is if side effects occur. These recommendations concern HSDD treatment, not every use of injectable testosterone.
8 sources behind this pagePrimary research, guidelines and a labelled meeting report. Regulatory context is listed separately below.
A 2025 cross-sectional Australian study of 1,104 women found median testosterone about 25% lower at ages 55–59 than at 40–44, with the lowest point near 58–59. Among participants aged 48–53, levels didn't differ by menopausal stage. These were comparisons between people, not a measured decline within each person, and menopause alone wasn't supported as a reason to supplement testosterone.
Wang, Islam, Bond and Davis; Australian Women’s Midlife Years Study
Cross-sectional blood-sample study, not a cohort trajectory or treatment trial. Participants were predominantly of European ancestry. NHMRC-funded; Davis disclosed advisory work for Besins Healthcare and institutional research funding and study products from Lawley Pharmaceuticals. The 25% comparison uses medians of 0.56 and 0.42 nmol/L; these aren't diagnostic thresholds.
Read the sourceAJMC's report of the 2025 Menopause Society meeting describes unproven or inconsistent benefits for muscle, bone, mood, cognition and fatigue-related outcomes.
Hayden E. Klein; October 31, 2025, reporting Susan R. Davis’s presentation
Conference reporting, not a trial, systematic review or new guideline. Fatigue discussion draws on vitality outcomes. The HSDD recommendation comes from the separate global consensus, not this article. No article-specific funding declaration is provided.
Read the sourceA 2026 conference abstract using US health records linked testosterone prescriptions after menopause with more cardiovascular events (3.8% vs 0.5% over about 3 years). It's an observational association that hasn't been peer reviewed and can't show cause; earlier observational studies disagree. Heart safety remains an open question that needs a proper trial, so it's worth discussing your own heart risk before starting.
Dr. Jen Gunter; October 2026, discussing a TriNetX abstract (Jiang et al.) at the 2026 Menopause Society meeting
Expert commentary on a conference abstract, not peer-reviewed research. The abstract matched 3,164 postmenopausal people per group (mean age 56–57, just under 3 years' follow-up) and reported 3.8% vs 0.5% composite cardiovascular events. Prescription records can't show dose, reason or whether it was taken, so reverse causation and under-recording are possible. Other observational studies conflict. No funding declaration for the commentary.
Read the sourceTestosterone improves sexual desire, arousal, orgasm and satisfaction in postmenopausal women with HSDD; evidence outside the sexual-function indication is limited.
Davis et al, on behalf of the IMS, NAMS, ESE, ENDO, RCOG, AMS, FSRH and others
The international consensus statement endorsed by every major menopause and endocrine society. The reference document for prescribing.
Read the sourceA meta-analysis of randomised trials found a small-to-moderate effect size of testosterone on sexual function in postmenopausal women, with no short-term signal for serious adverse events at physiological doses; long-term safety remains uncertain.
Islam et al
Read the sourceFor postmenopausal HSDD, preparations that produce testosterone levels above the premenopausal reference range, including pellets and injections, aren't recommended.
Compounded bioidentical hormone therapy, including pellet implants, isn't recommended as a routine alternative to FDA-approved MHT; concerns include lack of dose standardization, absent adverse-event reporting, and supraphysiologic peaks.
Subcutaneous testosterone pellets in women produce serum testosterone concentrations several-fold above the female physiological range, with associated androgenic side effects.
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